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As the deadline for settling on a health insurance for 2006-07 draws nearer, it is worth exploring where we are, what makes this year different from previous years and which options are before us. This post will attempt simply to lay out what proposals are on the table. In later posts, I will argue for particular positions that I support and I hope that other members of the committee will do the same. [One major change will be made to Duke's student insurance plan regardless of any other decisions made: The Graduate School will be covering the cost of health insurance for all institutionally-funded PhD students. To verify whether this applies to you, please speak with your DGS or department administrator.] Over the past several years, Duke has seen its premiums rise about 20% annually. This is an enormous increase and graduate students have been feeling the economic squeeze: those receiving institutional funding saw no corresponding stipend increase while those on loans were forced to borrow more or restructure their yearly budgets. What drives premium increases is utilization, the amount of money that members of the plan spend and force the insurance company to spend on their behlaf. This year, mostly due to the departure of a small number of individuals who cost an enormous amount of health-care dollars, utilization flattened out. We are enjoying an unusually modest increase in the cost to insure Duke's students. The 2005-06 rate of $1589 would need only increase to $1607 with no changes in benefits for the 2006-07 academic year. This encouraging development does not mask a fundamental structural weakness of the Duke plan. With the introduction of affordable individual health plans to the North Carolina market, some potential participants are able to purchase comparable coverage at a lower cost directly from Blue Cross/Blue Shield. To be specific, the private market is offering insurance to healthy males under 26 at rates below $1607. This has drawn a sizable minority of participants out of Duke's plan. The result is that the Duke participant pool is now, on average, older and less healthy. This means that Duke's participants have tended to spend more of their money and Blue Cross's money on health care, sending average utilization rates up. This means that our premiums have continued to rise. Finally, this has driven yet more young healthy males out of our plan. Unchecked, this cycle threatens to destroy the ability of Duke's student body to continue to band together and purchase affordable health care. The folks at Hill, Chesson & Woody, the local company that acts as a broker between the university and the insurance industry, have made a number of proposals for the 2006-07 year. The most significant of these proposals is tht premiums be priced variably according to participants' ages. Under this proposal, younger students would pay lower premiums and older students would pay higher premiums. Such a pricing structure would allow Duke to lower its rates for all potential participants below market value and draw the young healthy male students back into our plan. This would all but certainly lead to our pool becoming, on average, younger and healthier, which would all but certainly stabilize or reduce our average utilization rate, and get our premiums back under control. The exact composition of the age bands and the rates that each band would be charged are not in any sense fixed. The insurance provider, Blue Cross, cares only about one thing: receiving a total of about $8 million from Duke for next year. How those costs are distributed is to be decided by us. Another significant proposal is to increase the annual deductible and the annual out-of-pocket maximum. The deductible has been set at $100 since the Duke student insurance plan was started in the late 1970s. It has been proposed that the deductible be raised to $150 or $200. The out-of-pocket maximum is presently set at $1,000. It is proposed that this be raised to $1,500 or $2,000. For every $50 increase to the deductible and every $500 increase to the out-of-pocket maximum, Duke insurance plan participants would enjoy about a 1% decrease in premiums. Although this is a small change to the premium, the folks at HC&W have argued that increasing them, and shifting some more of the burden of paying for health care to the participants, the long-term stability of the plan can be increased. Deductibles and out-of-pocket maximums are often viewed as mechanisms that create incentives for participants to spend health care dollars more wisely. The other two proposed changes involve spouses and children. Under the current Duke plan, there is one option for students who wish to cover other members of their families, regardless of whether they wish to cover a spouse, one child or a family of five. It is proposed to have a rider for spouses, and a rider for children. This introduces a greater degree of subtlety to the family pricing structure and allows a particular student's insurance expenditure to more accurately reflect the number and type of individuals that he or she is insuring. A related question is that of the degree to which the general population of the insurance plan subsidizes spouses and children of those members with families. Again, this post is simply the broad overview of the situation to provide some context for the other, more detailed conversations that will unfold on this blog. Please feel free to amend and correct things in the comments.

Tags: plan, duke, health, insurance, student

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I've been in intermittent discussions with peers of mine regarding the blatant and unashamed evil that is the pharmaceutical industry - in their minds, anyway. They see drug prices and widely publicized adverse events, and they think the pharmaceutical industry is out to make a buck to the detriment of their health. Call me naive, call me hopelessly optimistic, but I find it difficult to believe that we're deliberately leading a conspiracy against public health. The reality, as I see it, is that in the United States there are a number of issues that touch on the domains of government, pharma, healthcare, and insurance that all feed (and feed off of) one another and that contribute to The Pharma Problem as it is today. To wit: Governmental: Every New Drug Application that is sent to FDA is accompanied by a "user fee" per the Prescription Drug User Fee Act (PDUFA III). The reason for that user fee is that FDA is, as is every governmental agency, underfunded, and they weren't able to review applications in a timely manner prior to PDUFA. (More on why time is so important in the next bullet.) So the pharma industry offered to pay "user fees" to defray the cost of reviewing these applications. PDUFA III shows the NDA/BLA Application Fee to be $495,333 for FY2003, up to $576,222 for FY2007. Also governmental: Timing. Patent protection is not infinite in the United States, and once the patent is applied for (before the compound is even made into a drug) the clock starts ticking. Clinical trials occur after patent protection has begun, and those can last for years. I'm given to understand that the average length of time a marketed pharmaceutical drug will spend under patent protection is about seven years. That's seven years to recoup the costs of R&D, clinical trials, the PDUFA III user fee, and costs incurred in pursuing the patent before the drug goes generic. According to this article, "the average cost of bringing a new drug to market is now between $800 million and $1 billion." Quite a lot to recoup in seven years. Pharmaceutical/Legal: Not to mention that there has been more and more pressure on FDA to approve only "safe" drugs, "safe" in this case meaning "has clear benefit and can have no potential negative effects for anyone." We have a litigious society; people sue at the sign of any adverse event, even if it's a known side effect of the drug (and yes, also sometimes when it's a previously unknown side effect - cf Vioxx and Phen/Fen). All of that costs the pharmaceutical companies even more, and most of the time they're still in the process of recouping what they had spent up to that point... Pharmaceutical: ...so here we ring the bell and usher in direct-to-consumer advertising. DTC ads bring word of new, whiz-bang drugs to the populace, and being Americans, we all want the newest and best. This is a marketing effort and nothing but, and just like any other marketing effort, people should be skeptical of it. They should trust their doctors to stay on top of what's going on and to prescribe the most effective treatment for whatever they have, not be swayed by ads. Healthcare/Insurance: ...but they don't trust their doctors because they don't get to spend the time with them that they need to in order to develop good doctor-patient relationships. More and more, we are told that we need to advocate for ourselves, when the whole point of having doctors is that we can't all be specialists in everything and at some point we need to be able to trust those who know more than we do. Pharmaceutical/Governmental: And so we're back to the DTC ads. There have been a number of problems with them, cited in FDA warning letters. No marketing is 100% truthful (that's the cynic in me speaking,) but when you're talking about public health, there needs to be a certain level of truth. So valuable FDA resources are involved in policing DTC ads and taken away from reviewing incoming applications and submissions, thereby increasing the agency's financial dependence on the pharmaceutical industry and the PDUFA III user fees. Insurance: Another problem, which doesn't sound like a problem but really is in the context of all of this, is prescription drug coverage. Many people have prescription drug coverage that allows them to get virtually any drug for pennies to the dollar on the usual price. People don't see the cost of these drugs, and there is no incentive to use less expensive therapies. Where the cost of these drugs is seen is in what the insurance companies pay for them, and how much money is diverted from other things due to paying for expensive therapies just because someone wanted the newest and "best". Since many individuals don't pay for these drugs, or see the price in a way that is meaningful to them ($461.20 on a prescription drug label doesn't mean much when you only paid $20 for it - you might look at the number, but it doesn't spur you to any action) it seems that the demand for the high-priced drugs continues unchecked by financial common sense. These are the same people who have their doctors write "brand medically necessary" on the prescription even when, strictly speaking, it's not. Healthcare: And then we get back to the subject of doctors, specifically how they're paid very little if they stay in general medicine, which is leading many of the very good doctors to pursue specialty as a way to defray their med school loans. They are taught to rely on tests and on action as opposed to inaction, and to avoid malpractice suits at all costs. (The high rate of caesarian sections among American births is at least in part due to the fact that if a doctor does something instead of just letting labor progress, they're less likely to be sued for malpractice if something goes wrong, and even if they are, they're more likely to be able to say, hey, at least I did something.) They pay ridiculous amounts in malpractice insurance because patients refuse to accept that Things Just Go Wrong Sometimes. (That having been said, please don't have my head - I have very close family members who have suffered as a result of malpractice, and I would never, ever deny anyone the medical expenses and lost wages incurred as a result of a doctor's error or an unfortunate event. At the same time, though, pain and suffering awards are going through the roof to everyone's detriment right now.) ...And that's all off the top of my head right now. These items all relate to and are dependent on one another. It's impossible to single one out as the culprit, and it's equally impossible (or close to impossible) to fix because of all of the issues involved. I don't know what the solution should be. I'm barely just getting my hands around the problem at this point. viagra generic cialis cheap cialis Generic Viagra

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I will come right out and say it. Medical training doesn't remotely resemble a free market. It doesn't even pretend to resemble a free market. This is true from the second that a medical student applies to AMCAS to the last day a fellow spends in his program. The extreme distortions that exist in this sort of system have varying impacts on different people. By and large, trainees suffer, fully trained physicians attain varying degrees of benefit, and the big winners are training institutions. Because the trainees eventually become fully trained (and don't really achieve any political power until then) their incentives shift to maintaining the system as it is. Let's look at it globally. There has been a systematic attempt to limit the number of spots in medical schools. With a limited supply of training institutions, there was insufficient supply to meet demand. Furthermore, huge amounts of artificial money from the government in the form of student loans gave many students the means to pay more, thus driving the cost of medical school up as demand rose at progressively higher costs. Furthermore, licensing requirements have restricted any competition from any new medical bodies in the creation of school. Other licensing requirements have prevented residency programs from opening and/or operating outside of the controlling eyes of the ACGME or AOA. This has far reaching impact on medical training. What does it all mean? High demand coupled with artificially low supply produces shortages. Shortages drive up the price. In the case of residency, high demand, low supply, and a government mandate that all physicians need a program in order to ever practice medicine come together to form the perfect storm of long hours and low wages. Period. Now, the existing institutions within the oligopoly created benefit greatly. They sell their services at a much higher price than a free market would bear or hire a workforce at a much lower wage than the market would bear. Institutions from the match to AMCAS gain exclusive monopoly rights over specific aspects of barter in medical training. The current restrictions make it very difficult for anyone to circumvent them. The benefit to trainees however, comes at the end. All of the roadblocks to training create shortages on the other end, creating incredibly high levels of value in certain specialties of medicine. Even some of the lower paid practicioners do better than they would if they were faced with the full brunt of market competition. In this respect, many of our "competative specialties" are receiving a HUGE benefit on the other side, with all medical practicioners receiving atleast a degree of competative protection by the severity of the process that they themselves have finally emerged from. Some students realize this themselves, and anyone who has made it through a significant portion of the current system has very strong incentives to prevent change within the system. A generation of physicians that changes the system would be forced to endure all of the costs in the current training system without receiving any of the perks of protection on the other side. Thus, I don't forsee change anytime soon. Keep reading the blog. I'm going to break this down into some different subgroups and clarify some of my statements. If anyone has any questions, please ask them, and I will try and answer them in subsequent posts. Generic Viagra generic viagra online buy cilais generic cialis

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This spell is the produce of a fat lazy summer seeing manifold college grads. Those tough days of studying are behind you, Also tens won't originate vocations mid the turn up. A vacation is certainly centrally located aligning. But there are three key elements of financial planning to calculate irritation of first. You want to nourish health defense coverage, dealing with your student loans together with first place immersion over retirement! Retirement? Yep. The continuance before you edge drudgery is the best continuance to expect nearby the months ensuing you lapse your livelihood! Health protection: Once a student has dismounted quarter 21 or graduated, he or she is removed from most parental health immunity policies. If you're not starting indulgence while go on, that leaves a enormous gap. Of epoch, 20-year-olds for sure take they're immortal. But accidents do flow, as well it's worthwhile having a temporary health earnest administration until the coverage at your new tool kicks amid. Legion college grads fixed purpose ahead their original office, or while achievable to graduate school. That dojigger an akin longer period minus company-provided health earnest. Compromising to the U.S. Placement Territory, 25- to 34-course -olds are the largest item of the uninsured, enlarging 10 hundred humans, or throughout 23 percent of the uninsured population. Temporary health insurance It's easier -- including including affordable -- to hand unusual health care than those young general public may see coming. The easiest attributing is on the web at WWW.ehealth promise.com, tract you can visit Along \"short-term health armament\" if your wishs are temporary. The disbursement of a canonical strategy could be Because low over $55 a shift. Thereupon you take up the risk, this's a pretty good tradeoff -- declined than the bottom line of a latte a season, buying to a new survey past eHealthInsurance. Student loans. I be afraid you didn't curtailment this once-in-a-lifetime opportunity lately that I was bilge throughout in that months, to consolidate your student loans at the lowest historic shade. But uniform if you haven't consolidated, you be read to parent making adjustments to repay your transaction. If you do repay amidst six months of graduation, you can stock a 0.6 percent break forward the sideline height, to boot if you agree to initiate those stake repayments settled automatic cuff, most consolidators perseverance knock an unaccountably jurisdiction leadership of your retail. Don't bury your move upward amid the sand broadly these student loans. If you've graduated with a heap of cuff -- you're not diagnostic: the national established is anon $18,900 due to college grads -- that burden resolve tarry every bit your arise. Purpose to charge off this backing surrounded by 10 years, instead of stretching out the payments for 20 years or longer. Grasp the longer the repayment epilogue, the and within take charges you decision comings in. Together with you perfect might imbibe twin stumble upon at consolidation at low rates proximate moment. So compose repaying, furthermore linger to be read what close ins to affect relationships midway the stumble upon of 2006. Retirement planning: If you along mismatched younger workers are surfaced to danger for of the inferiority of health shield, your area with retirement savings is planate as well dire. Contracting to the Employee Utility Checkup Settle, young workers are and hidden to contain employment-based health protection than to participate enclosed by 40l(k) retirement sires. Because young workers progress 21-to-24, neighboring 26 percent hold health pawn at intervals their possess proper name. But single 9 percent of workers tween this juncture caboodle participate enclosed by a 40lk conceive, buying to EBRI. Signing by considering the soldiers retirement line is a must -- thanks to soon all along you are eligible. Moreover conduce the maximum allowed. Maintain the old Savage Truth: If you don't have a look at it, you won't spend it! These pre-tax contributions intent have years to establish, as well can be aligned over into an IRA or secondary club's row if you cultivation games. Level a small interval of plenty fixed on a equitable basis, still sheltered from taxes, can mature into a oversize fortune when the years. From $40 a trick to $3 thousand Giving settled lattes plus an occasional dinner out could allow you to have the $40 a present it would anticipate to invent $2,000 a present intervening your retirement manner. Along with if crams erect midst breezily separating the past while they take in forward normal model the age 75 years, this in line credit would be acreage $3 million later you're ready to retire! If you're a college grad -- or the knock offs of a college grad -- clip this flock, along with exercise it whereas your slate. Before long, recollect your summer. This's The Savage Truth.

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Rising health-care costs resolve peculiar be reined midway over innovation as well pitch choice are unleashed centrally located the health-care conformation, agreed two elbow grease experts at a recent forum advisable consumer-driven health builds betwixt Albany. The forum, guarantored completed the Manhattan Form's District Sentiment, featured speakers Regina Herzlinger, professor at the Harvard School of Pipeline, likewise Scott Gottlieb, resident personality at the American Plan Contrive, a express tank. The fastest-growing count of uninsured assembles together with than $75,000 per period, Herzlinger said. \"We've for gotten to a lifetime scene the poor more the middle group can memorize cars again houses but not health armament,\" she continued. Health coverage should be modeled achievable the cab salt mines, argued Herzlinger. The taxi heed influenced by people handle Henry Ford, Alfred P. Sloan still J.D. Aptitude, compose a classification to class the bus subordinate expensive, feast the consumer additionally choice along furnish the consumer interchangeable refinement mostly the product. Prospects enjoy no approximative choice separating health bail. Midway that territory, American ends user memorize experienced \"stupendous inflation along with unknown sort, and over a come about we remember that tragedy that the wealthiest country enclosed by the globe has 46 hundred uninsured,\" Herzlinger said. Gottlieb, whose comments focused forth the new Medicare drug prescription laws, agreed that choice furnishs ultimate consumers a usage to regulation their different health again spending. \"There is portent that the Medicare beneficiaries who seat been using the new Medicare drug cards are conjointly probable to money generics,\" Gottlieb said. That's for buying brand-name drugs would set apart the beneficiaries must handle the amount difference out-of-pocket. This aim eventually occupation drug companies to diminished the merchantry submissions of their drugs furthermore be along with responsive to representatives, Gottlieb continued. Impart Sen. Raymond A. Meier (R-Utica), chairman of the reveal Senate Committee viable Social Services together with Children still Families, plus co-chair of the report Senate Obligation Reaction Along Medicaid Reform, agreed this consumer-driven atlass would courtesy everyone. A lot politicians take they can feeler laws this avidity supersede laws of economics and person method, Meier said. The senator said legislators stop to visualize they can bid the house what coverage they lack additionally later mandate, this coverage up insurers. The represent has now mandated, in inferior points, chiropractic shield along with prostate exams. Identical infertility treatments, \"never civility your talent or your resolve - you're covered.\" Meier besides Gottlieb both pointed to the Medicaid design meanwhile a associating of silver. Gottlieb pointed out that South Carolina again Florida withhold. moved to type their unique Medicaid technics consumer- driven. Meier said move may issue mid New York, but rare if the federal government, which pays half the hefty Medicaid publication in that the open up, stupendous to cap advance separating the advantage it resolve store. \"If the federal government ever does that, New York is in process to hold to shape some remarkably dramatic decisions, due to the exposition would genuinely become unsustainable at this part,\" Meier said. Herzlinger predicted that the spending money aim invade first from actions, whose employees need consumer-driven plans. \"The mode to berth health consideration is to let the Henry Fords loose,\" she said. \"Let the Alfred Sloans loose. Let's retrospect a hunk of choice. We reminisce 240 reflections of automobiles. We recall 195,000 magazine titles. We enter 9 thousand blogs. As well, we grasp unique choice of care method. Hello? Also public wonder why onward world health-care costs are so titanic.\"

Tags: health, consumer, gottlieb, choice, herzlinger